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INTRODUCTION

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Despite significant progress in the treatment of cancer, approximately half of all cancer patients would eventually succumb to their disease, with one third of the deaths happening within 6 months of diagnosis.1 Palliative care is an approach that improves the quality of life of patients and their families living with a life-threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.2 Good symptom management contributes not only to improving patients' quality of life, but also to supporting patients through intensive treatments. The 58th World Health Assembly3 emphasizes that palliative care should be represented as one of the four pillars of modern oncology, alongside the disciplines of medical, radiation, and surgical oncology. Indeed, as patients with advanced cancer live longer as a result of advances in cancer therapy, the need for palliative care is only going to increase.

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In this chapter, we shall discuss the structure, processes, outcomes, and challenges related to palliative care for advanced cancer patients. Specifically, we will address the various components of the palliative care team and organizational structure in the oncology setting. Following this, we shall review the key assessment and management strategies to physical, psychosocial, and existential distress in patients and their caregivers, and examine a number of palliative care–related outcomes. In the final section, we shall highlight several key challenges faced by palliative care, and the potential solutions to overcoming these barriers.

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STRUCTURE OF PALLIATIVE CARE

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The Palliative Care Team

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The nature of palliative medicine involves provision of care to patients with advanced disease who frequently experience complex symptoms and psychosocial issues. This necessitates a highly integrated interprofessional team with acquired expertise in symptom management, communication skills, and end-of-life decision making to provide comprehensive support to both patients and caregivers. A palliative care team typically consists of physicians, nurses, social workers, pharmacists, dieticians, chaplains, physiotherapists, and occupational therapists (Fig. 25-1). Depending on the local resources, other disciplines such as clinical psychologists, psychiatrists, music therapists, and art therapists may also contribute as part of the team.4,5

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FIGURE 25-1.

Interprofessional nature of palliative care. The multidisciplinary nature of palliative care allows the health care team to address patients' and their caregivers' physical, psychosocial, and existential needs in a holistic manner. Furthermore, excellent communication among team members (dotted line) allows the team to provide consistent messages, treatment plans, and direction of care.

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Because of the complex and ever-evolving needs of patients with advanced cancer, members of the palliative care team need to communicate frequently and regularly to share updated assessments, and to establish common goals of care and treatment plans. Good communication helps to ensure that the various aspects of ...

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